Clinical Outcomes and Revascularization Strategies in Patients With Low-Flow, Low-Gradient Severe Aortic Valve Stenosis According to the Assigned Treatment Modality

被引：35

作者：

O'Sullivan, Crochan J. ^{[1
,2
]}

Englberger, Lars ^{[3
]}

Hosek, Nicola ^{[1
]}

Heg, Dik ^{[4
,5
]}

Cao, Davide ^{[1
]}

Stefanini, Giulio G. ^{[1
]}

Stortecky, Stefan ^{[1
]}

Gloekler, Steffen ^{[1
]}

Spitzer, Ernest ^{[1
]}

Tueller, David ^{[2
]}

Huber, Christoph ^{[3
]}

Pilgrim, Thomas ^{[1
]}

Praz, Fabien ^{[1
]}

Buellesfeld, Lutz ^{[1
]}

Khattab, Ahmed A. ^{[1
]}

Carrel, Thierry ^{[3
]}

Meier, Bernhard ^{[1
]}

Windecker, Stephan ^{[1
,4
]}

Wenaweser, Peter ^{[1
]}

机构：

[1] Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland

[2] Stadtspital Triemli, Dept Cardiol, Zurich, Switzerland

[3] Univ Hosp Bern, Dept Cardiovasc Surg, CH-3010 Bern, Switzerland

[4] Univ Hosp Bern, Clin Trials Unit, CH-3010 Bern, Switzerland

[5] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2015年 / 8卷 / 05期

关键词：

aortic stenosis; coronary artery disease; surgical aortic valve replacement; transcatheter aortic valve replacement; LEFT-VENTRICULAR DYSFUNCTION; TRANSVALVULAR PRESSURE-GRADIENTS; OPERATIVE RISK STRATIFICATION; CORONARY-ARTERY-DISEASE; EJECTION FRACTION; SYNTAX SCORE; DOBUTAMINE ECHOCARDIOGRAPHY; CONTRACTILE RESERVE; REPLACEMENT; TRANSCATHETER;

D O I：

10.1016/j.jcin.2014.11.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study compared clinical outcomes and revascularization strategies among patients presenting with low ejection fraction, low-gradient (LEF-LG) severe aortic stenosis (AS) according to the assigned treatment modality. BACKGROUND The optimal treatment modality for patients with LEF-LG severe AS and concomitant coronary artery disease (CAD) requiring revascularization is unknown. METHODS Of 1,551 patients, 204 with LEF-LG severe AS (aortic valve area <1.0 cm(2), ejection fraction <50%, and mean gradient <40 mm Hg) were allocated to medical therapy (MT) (n = 44), surgical aortic valve replacement (SAVR) (n = 52), or transcatheter aortic valve replacement (TAVR) (n = 108). CAD complexity was assessed using the SYNTAX score (SS) in 187 of 204 patients (92%). The primary endpoint was mortality at 1 year. RESULTS LEF-LG severe AS patients undergoing SAVR were more likely to undergo complete revascularization (17 of 52, 35%) compared with TAVR (8 of 108, 8%) and MT (0 of 44, 0%) patients (p < 0.001). Compared with MT, both SAVR (adjusted hazard ratio [adj HR]: 0.16; 95% confidence interval [CI]: 0.07 to 0.38; p < 0.001) and TAVR (adj HR: 0.30; 95% CI: 0.18 to 0.52; p < 0.001) improved survival at 1 year. In TAVR and SAVR patients, CAD severity was associated with higher rates of cardiovascular death (no CAD: 12.2% vs. low SS [0 to 22], 15.3% vs. high SS [>22], 31.5%; p = 0.037) at 1 year. Compared with no CAD/complete revascularization, TAVR and SAVR patients undergoing incomplete revascularization had significantly higher 1-year cardiovascular death rates (adj HR: 2.80; 95% CI: 1.07 to 7.36; p = 0.037). CONCLUSIONS Among LEF-LG severe AS patients, SAVR and TAVR improved survival compared with MT. CAD severity was associated with worse outcomes and incomplete revascularization predicted 1-year cardiovascular mortality among TAVR and SAVR patients. (C) 2015 by the American College of Cardiology Foundation.

引用

页码：704 / 717

页数：14

共 27 条

[21] Clinical outcomes of patients with low-flow, low-gradient, severe aortic stenosis and either preserved or reduced ejection fraction undergoing transcatheter aortic valve implantation [J].

O'Sullivan, Crochan J. ;

Stortecky, Stefan ;

Heg, Dik ;

Pilgrim, Thomas ;

Hosek, Nicola ;

Buellesfeld, Lutz ;

Khattab, Ahmed A. ;

Nietlispach, Fabian ;

Moschovitis, Aris ;

Zanchin, Thomas ;

Meier, Bernhard ;

Windecker, Stephan ;

Wenaweser, Peter .

EUROPEAN HEART JOURNAL, 2013, 34 (44) :3437-U32

[22] Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction [J].

Pereira, JJ ;

Lauer, MS ;

Bashir, M ;

Afridi, I ;

Blackstone, EH ;

Stewart, WJ ;

McCarthy, PM ;

Thomas, JD ;

Asher, CR .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (08) :1356-1363

[23] Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic stenosis [J].

Quere, JP ;

Monin, JL ;

Levy, F ;

Petit, H ;

Baleynaud, S ;

Chauvel, C ;

Pop, C ;

Ohlmann, P ;

Lelguen, C ;

Dehant, P ;

Gueret, P ;

Tribouilloy, C .

CIRCULATION, 2006, 113 (14) :1738-1744

[24]

Sianos Georgios, 2005, EuroIntervention, V1, P219

[25] Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation [J].

Stefanini, Giulio G. ;

Stortecky, Stefan ;

Cao, Davide ;

Rat-Wirtzler, Julie ;

O'Sullivan, Crochan J. ;

Gloekler, Steffen ;

Buellesfeld, Lutz ;

Khattab, Ahmed A. ;

Nietlispach, Fabian ;

Pilgrim, Thomas ;

Huber, Christoph ;

Carrel, Thierry ;

Meier, Bernhard ;

Jueni, Peter ;

Wenaweser, Peter ;

Windecker, Stephan .

EUROPEAN HEART JOURNAL, 2014, 35 (37) :2530-2540

[26] Outcome After Aortic Valve Replacement for Low-Flow/Low-Gradient Aortic Stenosis Without Contractile Reserve on Dobutamine Stress Echocardiography [J].

Tribouilloy, Christophe ;

Levy, Franck ;

Rusinaru, Dan ;

Gueret, Pascal ;

Petit-Eisenmann, Helene ;

Baleynaud, Serge ;

Jobic, Yannick ;

Adams, Catherine ;

Lelong, Bernard ;

Pasquet, Agnes ;

Chauvel, Christophe ;

Metz, Damien ;

Quere, Jean-Paul ;

Monin, Jean-Luc .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 53 (20) :1865-1873

[27] Clinical Outcomes of Patients With Severe Aortic Stenosis at Increased Surgical Risk According to Treatment Modality [J].

Wenaweser, Peter ;

Pilgrim, Thomas ;

Kadner, Alexander ;

Huber, Christoph ;

Stortecky, Stefan ;

Buellesfeld, Lutz ;

Khattab, Ahmed A. ;

Meuli, Fabienne ;

Roth, Nadja ;

Eberle, Balthasar ;

Erdoes, Gabor ;

Brinks, Henriette ;

Kalesan, Bindu ;

Meier, Bernhard ;

Jueni, Peter ;

Carrel, Thierry ;

Windecker, Stephan .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011, 58 (21) :2151-2162

← 1 2 3 →